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Weckler, B.C.* ; Martin, R.* ; Kutzinski, M.* ; Bertrams, W.* ; Jung, A.L.* ; Pott, H.* ; Laakmann, K.* ; Schulte, L.* ; Ahnert, P.* ; Heider, D.* ; Ringshandl, S.* ; Seidemann, C.* ; Suttorp, N.* ; Witzenrath, M.* ; Wildberg, C.* ; Lehmann, M. ; Rohde, G.* ; Greulich, T.* ; Vogelmeier, C.F.* ; Schmeck, B.*

Blood eosinopenia (≤30/µL) as an early predictor of respiratory failure in community-acquired pneumonia: A prospective multicentre study.

Pulmonology 32:2611215 (2026)

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INTRODUCTION AND OBJECTIVES: Lower blood eosinophil counts have been associated with increased mechanical ventilation rates in patients with community-acquired pneumonia (CAP). However, the optimal eosinophil count threshold for identifying CAP patients at high risk of respiratory failure remains undefined. This study aimed to establish an optimal admission eosinophil count as a prognostic biomarker for respiratory failure in CAP. METHODS: This prospective, multicentre cohort study (PROGRESS) enrolled adult patients (≥18 years) hospitalised with community-acquired pneumonia (CAP). A receiver operating characteristic curve analysis with Youden's index was applied to identify the optimal eosinophil threshold for predicting mechanical ventilation. Associations were adjusted for corticosteroid use using multivariable regression. Additional outcomes - ICU admission and hospital length of stay - were compared between patients above and below the optimal eosinophil count threshold. RESULTS: An eosinophil count threshold of ≤30/µL was optimal for predicting mechanical ventilation. Patients with eosinophil counts ≤30/µL experienced significantly higher mechanical ventilation rates (15.5% versus 7.3%; p < 0.0001; RR 2.12, 95% CI 1.61-2.80), regardless of glucocorticoid treatment. They also exhibited higher ICU admission rates (23.1% versus 10.9%; p < 0.0001; RR 2.11, 95% CI 1.70-2.63) and longer hospital stays among survivors (median 8.0 versus 7.0 days; p < 0.0001). CONCLUSIONS: Admission eosinopenia (≤30 µL) is a robust, easily measured biomarker that predicts respiratory failure in hospitalised CAP. It supports early risk stratification and may guide timely escalation of care.

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Publication type Article: Journal article

Document type Scientific Article

Keywords Pneumonia ; Biomarker ; Blood Eosinophil Count ; Risk Stratification; Care-unit Admission

ISSN (print) / ISBN 2531-0429

e-ISSN 1660-3818

Journal Pulmonology

Quellenangaben Volume: 32, Issue: 1, Article Number: 2611215

Publisher Taylor & Francis

Publishing Place 2-4 Park Square, Milton Park, Abingdon Or14 4rn, Oxon, England

Reviewing status Peer reviewed

Institute(s) Institute of Lung Health and Immunity (LHI)

Grants PerMed-COPD
Bundesministerium fr Bildung und Forschung